Summary
A Bartholin gland cyst is a retention cyst arising from the ducts of the Bartholin glands. A Bartholin gland abscess develops when a cyst or obstructed duct becomes infected. Bartholin gland cysts manifest with asymptomatic or mildly uncomfortable unilateral vulvar swelling, while abscesses are characterized by painful, tender swelling that may be accompanied by fever. Bartholin gland cysts and abscesses are usually diagnosed clinically. A biopsy to rule out malignancy is indicated in certain patients, including those aged ≥ 40 years or with atypical features. Initial management of an uncomplicated, noninfected cyst can include sitz baths and warm compresses, which may promote spontaneous drainage or resolution over several days. Abscesses typically require drainage and fistulization, usually with incision and drainage followed by placement of a Word catheter. Recurrent cysts or abscesses may require repeat Word catheter placement or marsupialization to create a permanent drainage tract. Gland excision is reserved for refractory recurrent disease.
Epidemiology
- ∼ 2% of women are affected at some point in their lives by a Bartholin gland cyst or abscess. [1]
- Peak incidence: women in the reproductive age group [2]
Epidemiological data refers to the US, unless otherwise specified.
Bartholin gland cyst
Pathophysiology [1][3]
Blockage of the Bartholin gland duct → accumulation of gland secretions → cyst formation
Clinical features [1][3][4]
Bartholin gland cysts typically manifest as a nontender, unilateral vulvar swelling that develops gradually over weeks to months.
- Often asymptomatic
- Can cause mild dyspareunia
- Large cysts can cause discomfort when sitting and walking.
Diagnosis [1][3][5]
-
Clinical diagnosis: pelvic examination showing a unilateral, palpable, nontender mass at the posterior vaginal introitus
- Typically located at the 4 o’clock or 8 o’clock position
- May be fluctuant or tense
- Imaging: not routinely required for typical presentations
-
Biopsy: indicated to rule out malignancy if any of the following apply
- Age ≥ 40 years [1]
- Firm, fixed, or irregularly shaped lesions
- Recurrent lesions
- History of vulvar malignancy
Fever, erythema, and/or tenderness suggest a Bartholin gland abscess rather than a simple cyst.
Treatment [1][3][5]
- Small asymptomatic cysts: expectant management with sitz baths and/or warm compresses
- Symptomatic, large, or infected cysts: : excision or drainage (see "Treatment" in "Bartholin gland abscess")
Bartholin gland abscess
Pathophysiology [1][4]
- Blockage of the Bartholin gland duct → accumulation of bacteria within Bartholin gland or cyst → abscess formation
- Polymicrobial (more common) or monomicrobial infection with:
Clinical features [1]
Bartholin gland abscess typically manifests as painful, tender unilateral vulvar swelling that develops rapidly over days.
Diagnosis [1][4]
-
Clinical diagnosis: pelvic examination showing a unilateral, tender, fluctuant mass at the posterior vaginal introitus
- Typically located at the 4 o’clock or 8 o’clock position
- May be associated with surrounding erythema and edema (i.e., signs of cellulitis)
- Imaging: not routinely required for typical presentations
-
Microbiology
- Consider diagnostics for sexually transmitted infections.
- Bacterial cultures are not routinely required; consider if signs of cellulitis are present. [2]
- Biopsy: Consider to exclude malignancy in patients aged ≥ 40 years or with atypical features (see "Diagnostics" in "Bartholin gland cyst").
Management [1][4]
Approach [1][4]
- Perform Bartholin gland cyst or abscess drainage with fistulization.
- Manage concomitant genitourinary infection (e.g., UTI, STI).
- Consider antibiotic therapy for Bartholin gland abscess.
- Recommend sitz baths for comfort and hygiene.
- Ensure primary care or OB/GYN follow-up in 1 week.
Bartholin gland cyst or abscess drainage with fistulization [1][4]
- Indications: Bartholin gland abscesses or large symptomatic Bartholin gland cysts
-
Procedure
- Place the patient in the lithotomy position.
- Perform incision and drainage; through the mucosal surface of the cyst or abscess.
- Place Word catheter into cyst or abscess cavity.
- Inflate Word catheter with 2–3 mL of saline.
- Place end of Word catheter into the vaginal canal.
- Leave the catheter in place for 4–6 weeks or until it is spontaneously expelled.
-
Alternative procedures
- Marsupialization: Consider for patients with latex allergy, abscesses > 5 cm, or deep cysts.
- Sclerotherapy (e.g., with alcohol or silver nitrate) may be considered in selected cases.
Avoid needle aspiration or simple incision and drainage without catheter placement because of high recurrence risk. [1][4]
Antibiotic therapy for Bartholin gland abscess [1][4]
- Consider antibiotic therapy for patients with any of the following:
- Broad-spectrum antibiotics (e.g., trimethoprim/sulfamethoxazole, doxycycline) are recommended.
- See "Empiric antibiotic therapy for purulent skin and soft tissue infections."
Antibiotic therapy is not indicated for uncomplicated Bartholin gland abscesses. [1][4]
Management of treatment failure or recurrence [1][4]
- Repeat Word catheter placement: usually considered for early failure due to premature catheter expulsion
- Marsupialization: usually considered after 1–2 Word catheter placement attempts
- Excision: typically reserved for refractory recurrent disease or patients with an indication for biopsy (see "Diagnostics" in "Bartholin gland cyst")
Differential diagnoses
-
Bartholin gland carcinoma
- Epidemiology: primarily found in postmenopausal women
- Symptoms: gradual, solid, and painless enlargement of the Bartholin gland
- Diagnostics: biopsy
- Treatment
- Resection of the lesion
- If surgery is not possible or as adjuvant therapy: chemotherapy and radiation
- Folliculitis
- Epidermal inclusion cyst [1]
- Fibroma
- Leiomyoma [1]
- Squamous cell carcinoma
The differential diagnoses listed here are not exhaustive.